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Special coverage: Medicare

Fix drug plan, senators demand

A Senate committee presses Medicare chief Mark McClellan to solve glitches that have created, in one Democrat's words, "a fiasco."

By ANITA KUMAR
Published February 9, 2006

WASHINGTON - Angry U.S. senators berated the nation's top Medicare official Wednesday even as he outlined plans to fix technical and management problems that have stymied the new federal prescription drug program.

Mark McClellan, administrator of the Centers of Medicare and Medicaid Services, defended the success of the program, known as Medicare Part D, but was candid about the flaws. He pledged to make the new prescription drug plan easier to use for millions of America's elderly and disabled residents by mid April.

"I am very concerned about anyone who has experienced problems in getting their medicines," McClellan said. "We make no excuses for the problems. They are important, they are ours to solve, and we are finding and fixing them."

The Senate Finance Committee hearing comes after weeks of confusion in which pharmacists refused to fill prescriptions or overcharged customers because they couldn't confirm what plans people were on or what deductibles people should pay.

"This bill is a fiasco," said Sen. Kent Conrad, a North Dakota Democrat who originally voted for the program. "This bill is botched and bungled every step of the way. I have never seen a bigger failure of government since Katrina."

Facing a barrage of bright lights and photographers, McClellan calmly fielded questions from senators seated at the front of the packed meeting room. He did not fully answer some, but repeatedly assured them he was going to fix the problems.

A handful of senators, mostly Democrats, continued to press him.

Montana Sen. Max Baucus, the highest ranking Democrat on the committee, demanded McClellan provide specific deadlines for solutions.

"Give me a date," Baucus pushed.

Each time Baucus asked, McClellan offered explanations.

"Just give me a date," Baucus interrupted. "Date. Date. Date."

McClellan outlined the following changes:

Extending transition coverage for a beneficiary's current drugs from 30 to 90 days.

Hiring a company to help ensure pharmacists, states and plans all have the same information on patients.

Conducting daily transfers of information between Medicare and plans.

Reducing the wait time on the toll-free federal hotline, 1-800-MEDICARE, and increasing the number of customer service representatives from 3,000 to 7,800.

The hearing was one of the first opportunities senators have had to question McClellan since the program began Jan 1. McClellan, who answered questions for almost two hours, replaced his original prepared statement with a frank speech about problems and solutions.

"It is very easy to sit up here and say, "Well, I would have done a better job.' We are not here to assign blame or point fingers," said Sen. Charles Grassley, an Iowa Republican who chairs the committee. "The history is part of the record. But it's time to move on. Now is not the time to make excuses. We need to have productive conversations and decisive actions to correct the recent shortcomings."

About 3.6-million people have signed up for Medicare Part D drug plans since enrollment began Nov. 15. In addition, about 6.2-million poor people on Medicaid were assigned randomly to a drug plan.

The federal government hopes for 8-million to 10-million to sign up by the time enrollment ends May 15.

Many states including Florida have stepped in to help pay for drugs when questions arise about those who are eligible for both Medicare and Medicaid. McClellan said the federal government will cover state costs incurred until Feb. 15, and will consider extending the cutoff into March on a state-by-state basis.

"While we are pleased that millions of Medicare prescriptions are being filled every day, we are going to continue working around the clock, all over the country, to ensure every person with Medicare can use their coverage smoothly," he said.

McClellan said about 90 percent of those enrolled have been successful, but acknowledged that several hundreds of thousands initially had problems. The biggest problem is with those who enroll late each month and then expect benefits to begin immediately on the first of the next month, he said.

William Kageler, 65, an Inverness resident, said he was frustrated when he tried to contact the federal government to ask questions on the hotline and federal Web site.

"Sometimes it gets to the point you don't want to make a decision because it's too difficult," Kageler said. "I got a hunch that I'm not the only senior that feels this way."

McClellan said federal spending on the program will be 20 percent lower than expected this year because patients are choosing prescription drug plans with lower premiums and because competition between the drug plans has lowered the cost of the drugs. New estimates project premiums of $25 a month - about a third less than previously estimated.

The program also has saved money because fewer people than expected have signed up for low-income subsidies.

A divided Congress reluctantly approved the drug plan pushed by President Bush in 2003.

Almost 42-million elderly or disabled people - no matter their income - are eligible to enroll in one of dozens of programs offered by private companies that will be subsidized by the federal government. In Florida, 19 companies offer 43 drug plans.

Senators, mostly Democrats, asked McClellan if he would support legislative changes to the program.

"I voted for it. I want to make this work," said Sen. Ron Wyden, D-Ore. Baucus wants to standardize a limited number of drug plan options while Sens. Wyden and Olympia Snowe, R-Maine, want to bar plans from changing their lists of covered drugs until the annual fall enrollment period when beneficiaries can switch plans.

Just last week, the Senate rejected an amendment by Florida Sen. Bill Nelson that would have given beneficiaries until Dec. 31 - instead of May 15 - to enroll without penalty.

But McClellan refused to commit to any legislative changes, most of which are opposed by his boss, President Bush, and the Republican majority.

"Our focus is on taking any steps we can take administratively now," he said.

Times staff writer Stephen Nohlgren and researcher Angie Drobnic Holan contributed to this report.

[Last modified February 9, 2006, 15:21:35]